Document Detail


Incidence of contrast-induced nephropathy in patients with chronic renal insufficiency undergoing multidetector computed tomographic angiography treated with preventive measures.
MedLine Citation:
PMID:  18638601     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Contrast-induced nephropathy (CIN) is associated with adverse outcomes. Strategies for its prevention have been evaluated for patients undergoing invasive coronary and peripheral angiography, including treatment with N-acetylcysteine, sodium bicarbonate, and use of iso-osmolar nonionic contrast. Recently, multidetector computed tomographic angiography (MDCTA) of the coronary and peripheral arteries has been introduced as an accurate method for assessing vascular stenosis and has been widely adopted for assessment of outpatients with suspected coronary artery disease or peripheral arterial disease. To date, the incidence of CIN in outpatients with chronic renal insufficiency (CRI) treated with CIN-preventive strategies undergoing MDCTA remains unknown. Thus, we evaluated the incidence of CIN in outpatients with CRI (creatinine 1.5 to 2.5 mg/dl) undergoing MDCTA using CIN-preventive measures; 400 patients with CRI (78.5% men, mean age 76 years, 41% with diabetes) underwent MDCTA with iodixanol for detection of coronary artery disease or peripheral arterial disease (mean contrast volume 101 cc). CIN was defined as a nonallergic creatinine increase of >0.5 mg/dl. Creatinine levels were obtained before and 3 to 5 days after MDCTA; the average creatinine levels were 1.80 mg/dl and 1.75 mg/dl, respectively (p = NS), with an average change of -0.03 mg/dl. In the study cohort, only 7 patients (1.75%) experienced a creatinine increase >0.5 mg/dl, satisfying the definition of CIN. In conclusion, multivariate analysis, diabetes was the only predictor for CIN (odds ratio 5.9, 95% confidence interval 1.0 to 33.3, p = 0.045). No patient required hemodialysis. In conclusion, in patients with CRI undergoing MDCTA and receiving CIN-preventive measures, the incidence of CIN is low.
Authors:
Mohammad El-Hajjar; Iqbal Bashir; Muhammad Khan; James Min; Mikhail Torosoff; Augustin DeLago
Publication Detail:
Type:  Journal Article     Date:  2008-05-29
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-21     Completed Date:  2008-09-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  353-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiology, Department of Medicine, Albany Medical College, Albany, New York, USA. el-hajm@mail.amc.edu
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MeSH Terms
Descriptor/Qualifier:
Acetylcysteine / therapeutic use
Aged
Angiography / methods*
Contrast Media / adverse effects*
Coronary Angiography / methods
Creatinine / metabolism
Female
Humans
Kidney Diseases / chemically induced*,  prevention & control*
Kidney Failure, Chronic / complications*
Male
Sodium Bicarbonate / therapeutic use
Tomography, X-Ray Computed / methods*
Triiodobenzoic Acids / adverse effects
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Triiodobenzoic Acids; 144-55-8/Sodium Bicarbonate; 60-27-5/Creatinine; 616-91-1/Acetylcysteine; 92339-11-2/iodixanol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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